The Obama administration plans to reverse a regulation from late in the Bush administration allowing health-care workers to refuse to provide services based on moral objections, an official said Friday.

…Under the [Bush] rule, workers in health-care settings — from doctors to janitors — can refuse to provide services, information or advice to patients on subjects such as contraception, family planning, blood transfusions and even vaccine counseling if they are morally against it.

An unnamed Health Dept official said, “[W]e do not want to impose new limitations on services that would allow providers to refuse to provide to women and their families services like family planning and contraception that would actually help prevent the need for an abortion in the first place.”

I contemplated all the reasons that the Bush Administration’s rule would be terrible for women and gays and quoted ACOG and AMA objections to it.

I am so happy to hear that the Obama Administration is going to do away with this unnecessary and theocratic regulation. As the American College of Gynocologists states, “Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients [or] negatively affect a patient’s health.”

President Bush is physically and mentally incapable of passing on a chance to screw somebody over. Doing so in the waning months of his presidency through “Midnight Regulations” is like an early Christmas for him.

Take, for example, the proposed rule “Ensuring That Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices In Violation of Federal Law.”

Well, that sounds innocuous. No one likes coercion or discrimination!

But what should this rule turn out to be, than a vehicle to allow certain Christians the right to refuse reproductive health services to women in any and every conceivable scenario?

Funny, the title of the rule doesn’t mention this. The description fails to clearly identify the groups whose rights are being expanded, and the groups whose rights are shrinking. And… there are already several federal laws in place protecting “conscientious objectors” from being coerced into performing medical services they deem unethical or immoral, including the Church Amendments, section 245 of the Public Health Services Act and the Wheldon Amendment.

Why would we need another regulation to do the same thing? That’s were this proposed rule gets interesting. From the text of the rule: “There appears to be an attitude toward the health care professions that health care professionals and institutions should be required to provide or assist in the provision of medicine or procedures to which they object, or else risk being subjected to discrimination.” “Appears to be”? What is that? Somebody’s casual observation or anecdotal knowledge of an “attitude” they don’t like is enough to require presidential action? That sounds… odd.

“In general, the Department is concerned that the development of an environment in the health care field that is intolerant of individual conscience, certain religious beliefs, ethnic and cultural traditions, and moral convictions may discourage individuals from diverse backgrounds from entering health care professions.” Uh huh, suddenly we care about “ethnic traditions” and diversity in the health care field. Right. We all know the crap that’s about to follow is going to actually be about protecting a certain segment of the Christian community. Anything else is incidental.

Oddly, though the precedents cited in the proposed rule are all related to abortion and sterilization, this rule doesn’t actually specify that it only applies to these things. Instead, “…we propose that the term “health service program” should be understood to include an activity related in any way to providing medicine, health care, or any other service related to health or wellness…”

And this ain’t just about doctors: “…the Department proposes to include participation in any activity with a reasonable connection to the objectionable procedure, including referrals, training, and other arrangements for offending procedures. For example… an employee whose task it is to clean the instruments used in a particular procedure would be considered to assist in the performance of the particular procedure.”

So as you can see, this means that anyone with even the most tenuous connection to a given health service can refuse to perform just about any health service in any situation so long as they say they object to it on religious grounds. And if they object to a certain health service, they will not even be required to refer their patient to someone who can provide the service. It isn’t hard to imagine scenarios where lives could be at stake with these shenanigans.

This ain’t just about abortion any more. If this rule goes into effect, anybody can object to participating in any part of any health service provision and expect to keep their job. I wonder if certain groups of people, with members of said group currently in political power, will disproportionately enjoy the effects of this rule? I wonder if certain groups of people, currently out of favor with those in political power, will disproportionately suffer from this broad “right to refuse”?

“This regulation does not limit patient access to health care, but rather protects any individual health care provider or institution…” Oh. Whew, I was worried.

Last year, the American College of Obstetrics and Gynecology said a “patient’s well-being must be paramount” when a conflict arises over a medical professional’s beliefs.

In calling for limits on “conscientious refusals,” ACOG cited four recent examples. In Texas, a pharmacist rejected a rape victim’s prescription for emergency contraception. In Virginia, a 42-year-old mother of two became pregnant after being refused emergency contraception. In California, a physician refused to perform artificial insemination for a lesbian couple. (In August, the California Supreme Court ruled that this refusal amounted to illegal discrimination based on sexual orientation.) And in Nebraska, a 19-year-old with a life-threatening embolism was refused an early abortion at a religiously affiliated hospital.

“Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients [or] negatively affect a patient’s health,” ACOG’s Committee on Ethics said. It also said physicians have a “duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request.”

Well, what does the American Medical Association think? They do tend to favor the interests of doctors.

From the LA Times: “The American Medical Assn. and the American Hospital Assn. in October urged HHS to drop the regulation.”

Ah hah. Now we see exactly where this is going. So we can expect more incidents like those cited above with this proposed rule tipping, nay, slamming the balance between rights of the patient and rights of the medical worker way over to the side of the medical worker. And rather unambiguously, the patients whose rights will be overridden seem to be overwhelmingly female, with a small but significant number of LGBT patients to boot.

I feel like we’re right back at the culture war crap that I was discussing in my series about Demographic Winter. It’s the same shit!

In the lofty language of the proposed rule, it isn’t immediately clear who exactly stands to gain and who stands to lose. But when these concepts start to play out in real life, an undeniable picture forms. Socially conservative Christians want more latitude to discriminate against women and gays in health care and get away with it. So Bush & Co. draw up a broad bill that conceals this very specific agenda at the same time that it supports it.

The WSJ says: “It will take effect 30 days after being issued. That means that if the Bush administration issues the regulation this week, it will become final before Mr. Obama’s inauguration on Jan. 20, and his administration won’t be able to undo it easily.”

Its like if I took a job at starbucks and then announced that caffeine is against my religion and I will only take orders for the decaffinated beverages. Instead of telling me I have to do my job or leave, Starbucks would be required to either hire another person to look over my shoulder and do the parts of my job I won’t do, or allow customers to be refused their orders. Only instead of caffeine, replace it with time-sensitive critical medical care.

Exactly.

For more information:
You can find a PDF of the proposed rule at ProPublica
“Broader medical refusal rule may go far beyond abortion” from the LA Times
“The Abortion Wars Get Technical: Women have few rights at all when doctors can legally misinform them or deny service entirely” from Newsweek
“Bush-Era Abortion Rules Face Possible Reversal” from Wall Street JournalFeministe discussion: “Sorry, ladies, but your vagina conflicts with my morals.”